Ces radiol. 2018, 72(2):76-83 | DOI: 10.55095/CesRadiol2018/013

Endovascular treatment of aortoiliacal aneurysms with contemporary revascularisation of internal iliac artery by iliac branched stentgraftOriginal article

Martin Köcher¹, Petr Utíkal², Marie Černá¹, Petr Bachleda², Petr Dráč², Vojtěch Prášil¹, Jana Zapletalová³

¹ Radiologická klinika, LF a FN, Olomouc

² II. chirurgická klinika, LF a FN, Olomouc

³ Ústav lékařské biofyziky LF UP, Olomouc

Aim: Endovascular treatment of aortoiliac aneurysms requires anchoring of stent graft into the external iliac artery with covering of internal iliac artery origin. The covering of internal iliac artery of both sides is associated with higher risk of large bowel ischemia and buttock claudication. The aim of article is to evaluate our results of endovascular treatment of aortoiliac aneurysms or isolated iliac aneurysms with revascularization of internal iliac artery territory and to compare results with the group of patients without its revascularization.

Methods: From March 2010 to January 2018 27 patients (24 men, 3 women) with median age of 72 years (range 54-84 years) were indicated for the treatment of aortoiliac aneurysms or isolated iliac aneurysms with revascularization of internal iliac artery territory. Twenty eight iliac branched devices were implanted in 27 patients. Internal iliac artery of one side was revascularized in 26 patients, both internal iliac arteries were revascularized in one patient only.

Results: Primary technical success was achieved in all patients. Perioperative mortality rate was 0%, perioperative morbidity 3.7%. The median of duration of follow-up was 31 months (range 2-97 months). Primary internal iliac branch patency rate was 96.42%. Secondary endoleak was found at follow-up CT in 6 patients (1 endoleak type Ia, 1 endoleak type Ib, 4 endoleaks type II). In one patient inflammatory complication was seen. Significantly lower rate of buttock claudications (p = 0.024) and the total number of ischemic complications (p = 0.006) were found one month after procedure in the group of patients with revascularisation of internal iliac artery territory in comparison with the group of patients without revascularization and bilateral internal iliac artery occlusion. No difference of ischemic complications was found between these two groups one year after the procedure.

Conclusion: The implantation of a branched iliac component allows effective treatment of aortoiliac or iliac aneurysms with simultaneous revascularization of the internal iliac artery. Compared with treatment of aortoiliac or iliac aneurysms without revascularization of internal iliac artery teritory of both sides the simultaneous revascularization of the internal iliac artery teritory by branched iliac component reduces the incidence of early ischemic complications.

Keywords: abdominal aortic aneurysm, endovascular therapy, branched stent graft, internal iliac artery

Grants and funding:

Podpořeno MZ ČR - RVO (LF UP 61989592) a MZ ČR - RVO (FN OL 00098892).

Accepted: April 25, 2018; Published: June 1, 2018  Show citation